Nurse practitioner clinic lets dementia patients choose their own care — and it seems to work

What happens after a dementia diagnosis is often the hardest part of the disease. Medications may slow symptoms for a while, but nothing on the pharmacy shelf restores a lost hobby, a fading friendship or the confidence to keep walking the dog by the beach. Now a small Australian pilot study suggests that a clinic built around a radical idea — letting people with dementia choose their own non-drug treatments, week after week, for up to a year — may help them hold the line against cognitive decline, anxiety and shrinking quality of life.

The clinic, described in a brief report in Frontiers in Dementia, was led by a nurse practitioner and based at the University of Wollongong in regional New South Wales. Between September 2022 and June 2024, sixteen people living with dementia in the community attended the outpatient service. Eight of them consented to take part in the formal evaluation, and the findings from those who completed the twelve-month program point to something remarkable: participants largely maintained their cognition, psychological wellbeing and quality of life across the entire follow-up period. In a progressive disease where decline is the default expectation, stability is a meaningful result.

The scale of the challenge behind the study is enormous. More than 433,300 Australians live with dementia today, and projections suggest that figure will climb to 812,500 by 2054. Globally, the numbers are rising in parallel, and health systems are scrambling to find post-diagnostic support that actually works. Non-pharmacological treatments — a broad category covering cognitive stimulation, art therapy and physical exercise — have shown promise in clinical trials, but evidence on how to deliver them over the long term, in a way people will keep engaging with, remains thin.

The science underpinning each intervention category is distinct. Cognitive stimulation, which involves structured activities and discussions to enhance cognitive and social function, has demonstrated short-term benefits for people with mild-to-moderate dementia, though longer-term programs running beyond ten weeks have been less studied. Art therapy, which harnesses creativity to support cognitive, emotional and interpersonal skills, improves wellbeing and quality of life in other populations but the evidence base in dementia care is limited. Physical exercise, by contrast, has a growing evidence base suggesting it can effectively slow cognitive decline in people with dementia. The Wollongong clinic combined all three, plus yoga, under one roof.

What made the model unusual was who ran it. Nurse practitioners in Australia are advanced practice clinicians with an extended scope that includes autonomous assessment, diagnosis, prescribing and referral. That positioning allowed the clinic to integrate medical and psychosocial care within a single outpatient service — something most existing post-diagnostic models, such as the Meeting Centres Support Programme or Cognitive Stimulation Therapy groups delivered internationally by care staff, registered nurses and allied health professionals, do not attempt. The design process itself was consultative: two 60-minute sessions gathered input from healthcare practitioners, including exercise physiologists, aged care clinical nurse consultants, aged care provider managers and a geriatrician, as well as six people with lived experience of dementia.

Each participant began with an initial appointment in which the nurse practitioner gathered baseline information — medical history, occupation, hobbies, social activities, functional ability and specific areas of concern. That information shaped which activities were offered and how they were modified. From there, participants were invited to attend weekly for one to two hours, for up to twelve months, choosing how often they came and what they did each session. The menu included group and individual cognitive stimulation using puzzles, LEGO and games; group and individual art therapy with paint, clay, craft and drawing materials; exercise physiology sessions ranging from low to medium intensity with body weight exercises, treadmill, exercise bike and resistance training; fortnightly low-intensity yoga; and on-request appointments with the nurse practitioner to discuss health issues or arrange referrals to services such as Dementia Australia.

The pilot evaluation used validated screening tools to track change. Cognition was measured with the Rowland Universal Dementia Assessment Scale, a six-item clinician-administered scale covering memory, praxis, language, judgement, drawing and body orientation, where scores of twenty-three or less indicate cognitive impairment. Psychological wellbeing was assessed with the twenty-one-item Depression Anxiety Stress Scale, a self-report instrument whose subscale scores are classified from normal through extremely severe. Quality of life was tracked with the thirteen-item Quality of Life in Alzheimer’s Disease scale, which ranges from thirteen to fifty-two. Participants were interviewed at baseline, six months and twelve months, and because the sample was small and dementia is heterogeneous, results were reported individually rather than averaged.

The individual stories behind the numbers are where the clinic’s philosophy comes alive. Nora, a former artist whose right hand injury and visual-spatial changes from dementia were affecting her painting, chose art therapy and individual exercise physiology, later switching to jigsaw puzzles with one-to-one support — and kept walking her dog each day. Frank, who walked five kilometres up to four times a week with friends and maintained historical trains, selected group exercise and LEGO-based cognitive stimulation; within a month he progressed from needing one-to-one support on simple kits to completing complex ones with minimal help, finishing ten kits over the year. Lloyd, a keen golfer and former builder, kept playing golf and driving throughout. Harvey, a mechanical engineer, rower, gardener and ballroom dancer, maintained function even after recovering from a delirium following an overseas trip that temporarily cost him his driver’s licence.

Yet the quantitative data also revealed a subtle tension. Nora’s Depression Anxiety Stress Scale score registered zero for anxiety, but she reported feeling anxious — a divergence between standardised measures and lived experience that the authors flag openly. Frank’s stable scores, meanwhile, masked what the researchers describe as meaningful functional gains in confidence and participation. The authors note that the clinic was open only one day a week, which limited recruitment, and that because the study was clinician-led and unfunded, priority was given to the clinical intervention rather than data collection, leaving gaps at some timepoints. The findings, they caution, should be interpreted cautiously given the small sample size and the absence of a comparator group.

The policy implications may prove the most consequential part of the report. In Australia, funding currently focuses on medications, with non-pharmacological and multidisciplinary treatments for people with dementia overlooked, the authors argue. The Australian Government’s new Support at Home program, introduced in 2025, includes a Restorative Care Pathway offering allied health services for up to sixteen weeks, but details on access to centre- and group-based programs remain unclear. Economic analyses of scaling up cognitive stimulation therapy and the Care of People with dementia in their Environment program suggest such investments can pay for themselves by reducing hospitalisations, falls and care partner exhaustion. The Wollongong team, whose study was registered on the Australian New Zealand Clinical Trials Registry, has since launched a qualitative investigation exploring participants’ experiences of the clinic, and calls for funded feasibility studies and randomised controlled trials to test whether the model can scale. If the stability observed in this pilot holds up under rigorous testing, the idea that people with dementia should choose their own care may move from radical to routine.

Subject of Research: Health, Neuroscience and Behaviour

Article Title: Development, design and pilot evaluation of a nurse practitioner led outpatient post-diagnostic clinic for people with dementia and their care partners: a brief report

Article References: Montgomery, A., Hampstead, W., Molloy, L., Middleton, R., D’Cunha, N. M., & Marriott-Statham, K. (2026). Development, design and pilot evaluation of a nurse practitioner led outpatient post-diagnostic clinic for people with dementia and their care partners: a brief report. Frontiers in Dementia, 5, Article 1843734. https://doi.org/10.3389/frdem.2026.1843734

Image Credits: AI Generated

DOI: 10.3389/frdem.2026.1843734

Keywords: Development, design, pilot, evaluation, nurse, practitioner, outpatient, post-diagnostic, clinic, people, dementia, care